CentraCare physicians implanted world's smallest pacemaker

The CentraCare Heart & Vascular Center at St. Cloud Hospital is leading the way by being part of a clinical trial of the world's smallest pacemaker and offering new procedures that are less invasive.

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Tim Enneking presented the CentraCare Heart & Vascular Center a set of matryoshka stacking dolls depicting the doctors who performed the transcatheter aortic valve replacement procedure on his father Clarence. The matryoshka set was presented during a ceremony at the hospital July 24.(Photo: Jason Wachter, jwachter@stcloudtimes.com)Buy Photo

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CentraCare Health physicians implanted in a patient the world's smallest pacemaker this month

Last month, the hospital was the first in Minnesota to implant a second-generation artificial valve

CentraCare Heart & Vascular Center has done less invasive aortic valve procedure more than 50 times

Big things are happening at CentraCare Heart & Vascular Center at St. Cloud Hospital but on a very small level — and they are happening in more ways than one.

This month, the health care provider implanted in a patient a Medtronic Micra Transcatheter Pacing System, which is the world's smallest pacemaker; the procedure was part of a global clinical trial.

"This miniaturized technology is designed to provide patients with the advanced pacing technology of traditional pacemakers via a minimally invasive approach," Dr. John Schoenhard said.

The Micra TPS implant does not require a surgical incision in the chest and the creation of a "pocket" under the skin, which eliminates a potential source of complications and any visible sign of the device.

The electrophysiologist implanted the pacemaker, but it was not the only milestone for the Heart & Vascular Center; last month, the hospital was the first in Minnesota to implant a second-generation artificial valve: the SAPIEN XT.

"If positive, the results of the trial could potentially benefit the more than one million people globally who receive pacemakers each year," Schoenhard said.

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Clarence Enneking (left) talks July 24 with cardiac surgeon Dr. John Teskey. Teskey was on the team that performed Enneking’s transcatheter aortic valve replacement at the CentraCare Heart & Vascular Center.(Photo: Jason Wachter, jwachter@stcloudtimes.com)

Smallest pacemaker

The Micra TPS pacemaker is one-tenth the size of a conventional pacemaker — or about the size of a large vitamin — and is delivered directly into the heart through a catheter inserted in the femoral vein.

The world's smallest pacemaker does not require the use of wires or "leads" to connect to the heart. Attached to the heart via small tines, the Micra TPS delivers electrical impulses via an electrode at its end.

"It's a unified approach from our multidisciplinary team to try and continue to expand our tertiary services and establish us as a tertiary referral center for the area," Dr. Thom Dahle said.

The CentraCare Heart & Vascular Center cardiologist also referred to the center, which offers a full range of heart services, as one of the few sites in Minnesota with a heart research program.

Valve replacement

Patients with severe aortic stenosis, or narrowing of the aortic valve that obstructs blood flow, may benefit from transcatheter aortic valve replacement (TAVR), which is a less-invasive procedure than bypass surgery.

"Some of our counties are among the oldest in the U.S., and I think as our patients continue to age and live longer, it's more desirable to undergo less invasive procedures, such as the Micra TPS pacemaker or TAVR," Dahle said.

In a TAVR procedure, the cardiologist threads a catheter containing a collapsible valve in a stent through a patient's groin; the catheter makes its way to the aortic valve via the femoral artery.

The procedure also can be done through the chest wall for patients who have diseased arteries; the artificial valve is expanded inside the native valve by inflating a balloon.

"In TAVR, the major benefit is a quicker recovery time," said Dahle, director of the center's Valvular Heart Disease Clinic. "And I think the reason why we are so successful is just because of the cooperation at all levels."

Matryoshka stacking dolls depict the doctors who performed the transcatheter aortic valve replacement procedure on Clarence Enneking. The matryoshka set was presented during a ceremony at the hospital July 24.(Photo: Jason Wachter, jwachter@stcloudtimes.com)

Russian dolls

Clarence Enneking of Albany underwent the TAVR procedure in February at St. Cloud Hospital, but prior to that, the 82-year-old used a wheelchair and oxygen due to shortness of breath.

His son Tim, an international attorney, showed his appreciation to the CentraCare Heart & Vascular Center by commissioning special artwork on matryoshka (nesting) dolls made in Russia.

"You always have some concerns when you have an operation," Clarence Enneking said of the TAVR procedure, which took place at St. Cloud Hospital for the first time about a year ago.

"But with the situation I was in, that was about the only choice available, so I had to take it because I couldn't get any air; I couldn't do anything."

His 55-year-old son is relocating to San Diego from Moscow and surprised his father with the dolls at an unveiling (or unstacking) last week at the center; the dolls' artwork featured the patient and some of the TAVR team members.

"Through most of the winter, I didn't go anywhere except to doctors' appointment, and I was on oxygen for three months, 24 hours a day, and I could do very little," said Clarence Enneking, who now golfs daily — sometimes twice.

CentraCare Heart & Vascular Center has performed more than 50 TAVRs since June of last year, but Dahle said he was surprised at the number of TAVR procedures at the hospital.

"I kind of greatly underestimated the needs and demands in this population; my initial predictions were to do 20 implants the first year and maybe 40 implants our second year," Dahle said.

"The fact that we achieved 50 implants in our first year is a very staggering number of patients ... and I think those numbers will continue to grow ... but for us to do that many our first year is a major achievement."